Blog by Neil FrancisPosted on Tuesday 24th September 2024 at 11:54pm
The Dutch LZA-LP has just published its latest annual report.
Nearily two decades ago...
It seems like such a long time.
The Groningen Protocol
Back in 2005, the Dutch Paediatric Association (NVK) ratified what is known as the Groningen Protocol. It was adopted into the nation's regulations in 2006. It allows for the termination of a neonate's life in very particular circumstances, via strict processes, and reported to the regulating authority, the LZA-LP.
Only the most grave, extremis circumstances are eligible, for example Herlitz type epidermolysis bullosa, an untreatable condition that causes extreme internal and external blistering, and then death.
Then in 2013, the Dutch medical association (KNMG) released a medical media statement saying that each year, some 650 of 175,000 Dutch neonates will die not long after birth.
VAD opponents become enraged
Opponents of voluntary assisted dying (VAD) immediately became enraged, joining dots that didn't exist.
"After a decade of legalized assisted dying in the Netherlands, it is estimated that as many as 1 in 3 deaths in the country are from euthanasia [itself false] – including 650 babies each year." — Anti-VAD correspondent
The flood of false associations continued at least until 2016. It was then that I conducted a scholarly, forensic and exhaustive investigation into the Groningen Protocol, its history and its use, as well as documenting the trail of religious institutions running the "650 babies" association story up the media flagpole. I published a paper on it.
What's happened since then?
For appropriate reference, in the nine years immediately preceding the Protocol, there were 22 cases of neonatal euthanasia in the Netherlands.
That's not per year. It's the total over nine years. An average of a bit over two a year. Not 650.
And since regulation?
The LZA-LP has just released its 2022-23 report on neonatal euthanasia cases, so we're now up to date. And the figures are:
That is, in 9 years prior to the Groningen Protocol there were 22 cases, while in twice the period after its introduction (18 years), there were 3.
The findings show that shining a light on practice helps improve it. And that VAD, whose numbers have increased in the Netherlands, is not associated with a concomitant rise (but rather a major drop) in the small number of neonatal euthanasia cases.
I've yet to see any of the sources who spread "650 babies euthanised every year" misinformation publish a correction or refer to the LZA-LP annual reports. I wouldn't hold my breath, either.
More of the same
The "650 babies" caper is still doing the rounds.
Take Lord Alton of Liverpool for example. Last year he gave an address to a Catholic Social Thought forum, in which, after invoking Nazi Germany, he said:
"For those who would contend that infant euthanasia in the Netherlands is only permitted for rare and exceptional, cases, a Dutch commission on euthanasia argued in 2013 that as many as 650 infants should be eligible for the practice in the country each year." — Lord Aston of Liverpool
Actually, it was the Dutch medical association, not the Dutch euthanasia commission. It was 650 babies die, not "should be eligible for euthanasia". And the already small numbers have radically dropped, not risen.
But let's not let the facts get in the way of a good story.
Marshall Perron addresses the National Press Club in 1996
Marshall Perron is a former Chief Minister of the Northern Territory of Australia, and responsible for the world's first legislation to legalise voluntary assisted dying in restricted circumstances. The law came into effect in 1995 but was extinguished by federal legislation in 1996.
This video is Perron's pioneering address to the National Press Club in Canberra, prior to the Northern Territory legislation being extinguished.
Note: audio may not work in some browsers (e.g. Firefox). If so, try a different browser.
Note: If all you see is a black screen when you access the video, you must scroll down a little to see the play controls.
Legals
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Blog by Neil FrancisPosted on Wednesday 6th April 2022 at 6:35pm
Dutch and Belgian VAD rate analysis as at 2016
Through the lens of Covid lock-downs, six years ago seems like an eternity ago, doesn't it? But it was back in 2016 that I published a major analysis of voluntary assisted dying rates and practice in the Benelux lowlands, focusing a bright spotlight on the Netherlands and Belgium.
Using authoritative and robust data, I indicated that the ongoing rise in both countries' VAD rates would level out at rates that were culturally bound. This despite persistent hyperventilations of VAD opponents that most of us would eventually be "knocked off" by not-so-voluntary euthanasia. Generally, the adoption of behaviours at the societal level tends to follow a sigmoidal (stretched S-shaped) curve, and the then VAD data was consistent with this phenomenon.
The above chart is data I presented in 2016, with third order polynomial fits. A few things worth noting:
Both countries' VAD legislation came into effect in 2002.
Their legislation is quite similar, with only small differences.
Belgium provides a microcosm of cultural analysis because the national legislation applies to both the Dutch-predominant north (Flanders) and the French-predominant south (Wallonia).
The Dutch data starts well above zero because it had permitted VAD by regulation (not legislation) for some two decades prior to the legislation.
The late drop in the Dutch trend line is not so much a prediction, but a mathematical curiosity of third order polynomials. I did not predict a drop after leveling off.
The separate data for Flanders and Wallonia is measured by the proxy indicator, language (VAD reports filed in Dutch versus French). This is not perfect, particularly since Brussels, counted by the Belgians as a third official and separate region, speaks mostly French but is situated in Flanders. Nevertheless, it provides a powerful indicator of cultural differences in practice under the same laws.
In March last year the Belgian euthanasia commission published its 2020 report card. I re-analysed the data and wrote that the Netherlands' natural VAD rate seemed to be around 4.3%, and Belgium's (nationally) around 2.4%.
In April last year, the Dutch euthanasia commission published its 2020 report card. I analysed the data again and wrote that due to increased total deaths in 2020 due to Covid-19, the seeming drop in the VAD rates was an aberration and the rates would likely be slightly higher for 2021. This proved to be correct.
The very latest data
The other day, the Belgium euthanasia commission published a brief report of the statistics for 2021, and the Dutch euthanasia commission had also published its 2021 report card. So I thought this was an excellent opportunity to update our knowledge about culture and VAD rates.
And here's the same chart as above, updated with all data up to 2021.
Dutch and Belgian VAD rate analysis as at 2022
The Dutch VAD rate indeed has levelled out at around 4.3%, and the Belgian rate at around 2.4%. The Dutch rate is quite close to the prediction of 2016, while the Belgian rate is actually a bit lower than the 2016 prediction.
And the cultural difference between Dutch and French-speaking Belgians continues, with the Belgian Dutch VAD rate higher and closer to the Netherlands (of course, Dutch) rate. And the French-speaking rate seems not to have quite reached its resting place yet. That might well take another five or more years.
So, here's another general prediction. There will be further rises in the VAD rate, but they will be small, and long-term. This is because a majority of VAD occurs in relation to cancer, and cancer, statistically speaking, makes an appearance in the 50s age bracket, and peaks in the 60s and 70s. And populations in these countries, as around the world, are ageing.
But at no stage was hyperventilation warranted that significant numbers of people would be pressured into VAD, because there was a period of cultural "settling" in regard to both a personal preference for VAD in response to extreme and unrelievable suffering, and accessibility of VAD.
Blog by Neil FrancisPosted on Thursday 13th January 2022 at 11:00pm
Marion Harris published an eye-wateringly illogical op-ed in The Australian
Dr Marion Harris recently published another op-ed, this one in The Australian, against legalising voluntary assisted dying for the terminally ill. Her “reasoning” is inane, failing the basics of Logic 101 and offering up misinformation about palliative care. It also comprehensively fails to mention her deep underpinning Catholic ideology.
Dr Marion Harris is an experienced Melbourne-based oncologist. Having practiced for some twenty years, she’s co-authored research papers published in the peer-reviewed medical literature regarding the assessment of treatments for particular kinds of cancer.
You’d think that such experience and attention to evidence and proper deduction would give rise to a moderate and thoughtful approach towards legal VAD (even if opposed) and on other more general matters. But she offers quite strident nonsensical arguments.
Inane logical flaw
The lead reason that Dr Harris advances against VAD is that people will feel coerced to take the option. She cites three cases of people who decided to pursue intensive medical treatment for cancer instead of pursuing VAD, and who she states would all have been eligible for VAD. This means she says that they would have been expected to die within six months. She then notes they’re all alive and doing well — relatively speaking, with significant medical conditions — more than a year later, due to pursuing intensive medical interventions.
I emailed Dr Harris and she confirmed that these were indeed Victorian medical cases personally known to her.
With the chosen cases outlined, she claims that “the option of VAD ignores these possibilities [of further treatment]”. That is, in the state of Victoria where she works and where VAD is legal as she acknowledged in her article, she opines that VAD would stymie such medical interventions.
So, Dr Harris argues, using three cases of patients pursuing further treatment in a state with lawful VAD, that patients will not pursue further treatment if VAD were to be made lawful. (Her op-ed is clearly aimed at NSW MPs who are currently considering VAD legislation.)
It’s as whacky as the theory that the reason you never see elephants hiding in treetops is because they’re good at it.
And it flies in the face of clear documentary evidence of careful practice published by Victoria’s own Voluntary Assisted Dying Review Board, which Dr Harris doesn’t mention. We can only wonder why not.
Dr Harris inanely argues that people won't pursue medical treatment if VAD is legal, by describing three cases in which they did while VAD was legal.
Hubris?
A possible explanation for Dr Harris’ claim that people will be vulnerable to VAD when it is legal is that while she refuses to participate, doctors who do participate would not offer any and all available medical interventions that might help. But this this would be a shabby accusation against other doctors. Indeed, VAD law mandates that the patient be fully informed about treatment options as one of the qualification criteria should they apply.
Such an opinion about medical colleagues might also suggest a certain level of hubris and harsh attitudes about others. So perhaps this is not what she means, though other explanations for her conclusion are more elusive. We can only wonder, because Dr Harris has publicly stated in writing:
“People are free to suicide but no-one has the right to expecct [sic] their govt to kill them on request.”
“Boo hoo Ita … cry us a river … get over yourself” in response to ABC Chair Ita Buttrose saying she felt disrespected by Communications Minister Paul Fletcher.
“Ha ha – nailed it” in response to a post “@JoeBiden ankle injury update ….. cause was falling over a box of @realDonaldTrump ballots in his basement.”
“Very true” in response to a post stating that if Victoria’s Chief Medical Officer Professor Brett Sutton were put “in charge of climate emergencies he’d issue matches to every pyromaniac in Victoria, punch holes in the fire hoses at every CFA, then stand back and giggle while the state burned.”
She’s also retweeted comments that Donald Trump is the only person who can save the world from the Chinese Communist Party, and that the 2020 USA presidential election was “stolen” by election fraud.
Misrepresenting palliative care
In her article, Dr Harris argues again that palliative care is “the answer” despite both Palliative Care Australia and the Australian and New Zealand Society for Palliative Medicine clearly stating that palliative care can’t help everyone, and that a small minority suffer badly leading up to death.
While a small but meaningful minority, such cases of suffering in extremis are not “very rare” as Dr Harris wrongly states.
Dr Harris wrongly states that palliative care eliminates the need for VAD legislation. The peak bodies for palliative care in Australia state that while palliative care helps many people, it can't help everyone. Nor should we expect palliative care to be the only medical discipline to be infallible. That would be cherry-picked, confected nonsense.
A bright spot
In her favour, Dr Harris does at least acknowledge in her article that people can have “genuinely chosen a VAD pathway for themselves”.
The Catholic Communicators’ Guild
I’ve written before about the Catholic Church and its network of anti-VAD communicators, many of whom don’t reveal their religious ideology. One can only wonder, given Archbishop Anthony Fisher’s active call to find willing “spokespeople” for the Church, if it has directly recruited Dr Harris to its anti-VAD campaign — or whether she’s merely a privately motivated individual.
Either way, there’s no shortage of evidence of Dr Harris’ very, very deep Catholic roots indeed. On Twitter, she follows, for example:
Pope Francis.
Vatican News.
Catholic Bishop Tim Harris, the church’s spokesperson against VAD.
Catholic Archbishop Anthony Fisher (Sydney).
Catholic Bishop Richard (‘Down’) Unders (also Opus Dei: Sydney).
Catholic Archbishop Peter Commensoli (Melbourne).
Catholic Archbishop Mark Coleridge (Brisbane).
Jeremy Stuparich, Public Policy Director, Australian Catholic Bishops Conference.
Xavier Symonds, Research Fellow, Plunkett (Catholic) Centre for Ethics.
National Catholic Register.
Catholic News Agency.
Catholic Arena (Catholic news and opinion).
The Catholic Leader.
Father Andrew McDonald (Canadian Catholic priest).
The Society of St Sebastian (Catholic and Orthodox).
She warmly retweets posts from Catholic sources. Her posts are also consistent with the Catholic Church’s stances on sexuality and abortion, though her attitudes in denial of global warming are inconsistent with the Vatican’s, which supports efforts to combat it.
Indeed, in June 2021 she co-authored a similar op-ed also in The Australian, again replete with Catholic talking points. The other author was Emeritus Professor of Medicine Haydn Walters. What The Australian failed to declare is that Dr Walters is a board member of the innocuously named “Christopher Dawson Centre for Cultural Studies”. The stated aim of this organisation, nestled directly within the Catholic Archdiocese of Hobart (it shares the church's head office address), is chillingly arrogant: “to promote awareness of the Catholic Intellectual Tradition and Cultural Patrimony as essential components of human civilization”.
Dr Harris even directly defends the Church. For example, in response to a post criticising the Church as incoherent for saying it would never abandon people who choose assisted dying, yet says it is likely to deny last rites and pastoral care for those who do, Dr Harris wrote:
“Well the church is actually correct - the person is about to have an elective assisted suicide which is very different to a natural death so it does seem reasonable to question giving last rites - it’s the persons choice to select VAD and choices have consequences…”
Dr Harris provides ample evidence that she is a devout and traditional Catholic. That is her right. Curiously, though, she never mentions personal religious foundations for her views on VAD which align so strongly with Catholic Church talking points.
Conclusion
Dr Marion Harris’ anti-VAD tirades follow the same talking points as the Catholic Church and its network of communicators. In the current op-ed alone, she’s crafted an inane failure of logic, and employed misinformation about palliative care, to curry fear of responsible VAD law reform.
The invective apparent in some of her musings does her reputation no favours. While her personal view to never participate in VAD is deserving of respect, I argue that denying others their own choice of conscience, especially on the basis of misinformation and dumb logical falsehood, is not.
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For the record
For those wanting to run the "religious persecution" flag up the pole, this article is not for you. I wholeheartedly endorse Dr Harris's right to both her religion and her personal rejection of VAD. This article does not claim that Dr Harris's arguments are wrong because they are Catholic. It is to say, with appropriate reasoning (which Dr Harris failed to employ) and evidence that the claims she makes about VAD in her op-ed are illogical and poorly informed. They are an offence to acknowledging and protecting the different and deeply held ethical views of others.
The link I make to Catholicism is to point out how much of the nonsense promoted against VAD law reform is a malodorous vapour emanating from a seeming (and not infrequently actual) coordinated effort of a Catholic Church intent on imposing its views on all Australians, Catholic or not. Most Australians are not Catholic. And most lay Australian Catholics support VAD.
As I explain in a separate research series about Religiosity in Australia, the Church's intransigent attempts to trample the consciences of its own flock (let alone all Australians) is one of the reasons citizens have been abandoning the pews in droves in recent times.
Blog by Neil FrancisPosted on Monday 13th September 2021 at 8:07pm
Catholic Archbishop of Canberra/Goulburn Christopher Prowse. CC: Bart-1011
Last month, the Catholic Archbishop of Canberra & Goulburn, Christopher Prowse, published an opinion piece about VAD in the Canberra Times. Naturally, Prowse's views were opposed, which is fine. A range of views is always welcome. Misinformation, however, is not.
It would be unreasonable to expect that the opinion editor of the Canberra Times, Andrew Thorpe, would be intimately versed in the empirical evidence about voluntary assisted dying (VAD). So, it was reasonable that he publish an opinion piece on the topic offered by Archbishop Prowse. What is not reasonable, however, is that the counter-opinion I promptly submitted, pointing out several points of significant misinformation, was not published. A month later, still nothing.
A critical feature of high-quality, mainstream media journalism (which includes editorialism) is to ensure that the public can be exposed to a range of views on important topics, and that those views are generally devoid of significant misinformation. I argue that the Canberra Times has profoundly failed in this instance, and could profitably reflect on improving its conduct.
Here's the op-ed I sent, which they failed to publish.
Archbishop Prowse sadly misinformed on assisted dying
Catholic Archbishop Christopher Prowse’s recent editorial against voluntary assisted dying (VAD) (Canberra Times, 11 Aug) contains numerous items of misinformation about the practice. While a range of views is welcome, misinformation is not an acceptable standard in public debate about such an important topic.
Unsurprisingly, Archbishop Prowse argues that more palliative care is “the answer” to end-of-life suffering. This ignores formal statements by both Palliative Care Australia and the Australian and New Zealand Society for Palliative Medicine acknowledging that even the best palliative care can’t address all extreme suffering. It’s not like he wouldn’t know: the Catholic church is the largest single institutional provider of palliative care services in the nation.
His editorial also paints VAD deaths as “fearful”, “depressed” and “lonely”. This not only contradicts evidence published in peer-reviewed scientific research and official reports from lawful jurisdictions, but is a slap in the face to those who have chosen a VAD death, and to their families.
For example, the second person to use WA’s VAD law was Mary-Ellen Passmore. Her family and friends gathered to say farewell and sang Hallelujah together during her final moments. Loved ones of those who have accessed VAD in Victoria have described the experience as “peaceful” and “beautiful”.
Ms Passmore was also an indigenous community leader. This is relevant because Prowse argues that indigenous Australians would be fearful of VAD law, avoiding needed medical services.
This old chestnut has been rattling around since the Northern Territory VAD days in the 1990s, but was dismissed as false after a formal investigation found no change in indigenous medical service attendance. Indeed, a parliamentary inquiry heard that it was church members [not referring to Prouse or his diocesan colleagues] who were causing any indigenous fears.
Prowse also enlists “elder abuse” into his supposed army of the “vulnerable”. But a key feature of elder abuse is that it’s commissioned in secret, while VAD has numerous points of assessment, referral, review and documentation by trained professionals.
Perhaps the most egregious misrepresentation is his claim that “reasons for euthanasia quickly expand once legalised”, levelling specific claims about the Netherlands.
In fact, the Netherlands made VAD lawful by regulation in the mid-1980s. Several test cases in following years clarified that certain conditions (like extreme and unrelievable mental suffering) qualified under the regulations. These were formalised (not changed) in legislation in 2001. And that legislation hasn’t changed since. Not. One. Word.
One could be forgiven for thinking that the archbishop represents the views of Catholic Australians. But this isn’t true either. ANU studies show that some three quarters of Catholic Australians support lawful VAD.
I analysed the major 2019 data set of VoxPop — the academics who run VoteCompass — about VAD attitudes in the archbishop’s own archdiocese. It comprises the ACT and the NSW electorates of Bega, Cootamundra, Goulburn, Monaro, and about a third of Wagga Wagga.
With a VoxPop respondent count across the archdiocese of more than 34,000 people, four out of five voters favour lawful VAD with just 9% opposed. Not only that, but more than three out of four Catholic voters (76%) in the archdiocese favour lawful VAD, with just 13% opposed.
Voter attitudes toward VAD in the Canberra-Goulburn Catholic Archdiocese
Source: VoteCompass/VoxPop 2019.
~ Archdiocese totals weighted by elector count per district, Wagga Wagga weighted as 1/3 of.
Thus, not only does Archbishop Prowse seem unfamiliar with VAD facts, he seems remarkably unacquainted with the real views of his own flock.
Prowse argues that we are all “made in the image of God so we have dignity”. As an agnostic I’m happy for him to believe such things, though I say that everyone has dignity and life is precious regardless.
But when the archbishop proclaims that allowing VAD is “abandonment” of the person and that his views must prevail over all Australians, I call out hubris. “Abandonment” is to deliberatively seek to quash the deeply-held values and beliefs of others.
Blog by Neil FrancisPosted on Wednesday 26th May 2021 at 4:03am
A new book of anti-VAD polemical anecdotes, published by Springer
The other day a TV commercial from more than 30 years ago popped into my head. It was a humorous slice-of-life scene in which a teenage son gobbles down a breakfast bowl of Sultana Bran cereal. He complains that his health-kick girlfriend had made him eat vegetarian the night before. His family eye each other with mirth as he eats.
The punch line? “Don’t mention it’s healthy and they’ll eat it by the boxful.”
The Kellogg's Sultana Bran TV commercial from 1990.
Despite having worked in advertising research for years, I’m sure I hadn’t thought of this ad for at least a couple of decades. So what brought this vignette suddenly to mind?
It was the release of a new book by academic publisher, Springer: Devos, T, (Ed.) 2021, Euthanasia: Searching for the Full Story - Experiences and Insights of Belgian Doctors and Nurses, Springer, Leuven.
How terrific to have a new academic tome on the Belgian voluntary assisted dying (VAD) experience, I thought, as I downloaded the eBook version.
But then…
Imagine my surprise and disappointment then, to discover this is no scholarly tome with ethics-committee-approved study methodologies, carefully cited and transparent sources whose authenticity and veracity could be checked by anyone with a smidgin of scholarly acumen.
No, the kindest description I can give this blancmange of offenses is… a series of “essays” all singing from the same hymn sheet. More on that shortly.
The book launches into — let’s not beat about the bush — bullshit from the get go. In the Foreword, Jacques Ricot invokes the Hippocratic Oath as a still-relevant “religious standard”. Oh dear. You mean that oath that prohibits surgery, prevents women from entering the profession, and swears allegiance to ancient Greek gods?
He then goes on to describe VAD as a “desperate act of two people [the doctor and patient] trapped by helplessness.” He invokes cracks opening up in sea walls and waves that can only widen them. There’s your horizontal oceanic equivalent of the inevitable “slippery slope”.
Helpfully, he forewarns that all the authors in the book “do not believe that euthanasia can be a medical or a caring act.” OK, so not a range of views, then.
He also refers to the authors as “resistance fighters”, giving a heads-up that these writers feel they’re losing the battle.
And yet more
Then, anti-VAD campaigner Margaret Somerville repeats her rubbish claims that legalised VAD leads to suicide contagion. I’ve repeatedly taken Somerville to task over her serial misinformation, as well as noting the latest evidence from Switzerland which VAD opponents never mention… for a reason.
Somerville repeats yet again her refrain that “the case against [versus for] euthanasia is much more difficult to promote … because it is more complex”. No, it isn’t. It’s just that the majority now no longer take conservative religious doctrine as … shall we say, “gospel”. That’s especially true when her strongest ambit is to appeal to “a human way of knowing” (without mentioning her hobby horse, “moral intuition”, by name), and expressly noting that the stories that follow are not based on the usual scientific standards of evidence.
And there you have it. A series of “essays” by persons ideologically opposed to VAD, adorned with numerous uncheckable anecdotes and tawdry claims, appeals to slippery slopes, misrepresentation of data such as the non-voluntary euthanasia rate in Belgium, “intuitive” claims that the bereaved suffer as badly from lawful VAD as do families of those who have suicided violently and alone (despite multiple peer-reviewed studies showing VAD bereaved cope well). The list goes on.
Who are these people?
This of course begs the question: who are these people putting themselves forward as experts in VAD? Remember, these are people claiming expertise in a subject they’ve never participated in, and swear they never will. No doubt they are indeed experts in their own individual disciplines. But not in VAD.
It’s like asking (only) a bunch of hardened atheists to write an authoritative book on Christian spirituality.
Well, many of the names are already well-known in VAD (and especially anti-VAD) circles. Others took a bit of research to track down. Much of the work for the following backgrounders was accomplished by my friend the talented Chrys Stevenson. We compared notes.
The point of the research was not to attempt an inappropriate ad hominem attack. Without attempting to bore, I’ve already given a host of reasons as to why the quality of the essays in this book are very low. No, the point is to find common influences and agendas as to why that might be.
So lean in, dear reader, here we go. And to aid comprehension, may I suggest that you watch for the words in bold?
The editor — Timothy Devos
Timothy Devos is a Professor of Medicine (haematology) at Catholic University Leuven. He is a past president of the Medicine and Dignity of Man Association, an apostolate of the Catholic Regnum Christi movement, which believes that “the positions adopted by the Catholic Church in matters of bioethics are good, prudent”.
Foreword 1 — Jacques Ricot
Jacques Ricot is an Associate Researcher at Nantes University in France. In a 2003 paper he argues that secular philosophy needs to draw on the religious understanding of forgiveness. In 2014 he attended a conference on “dying with dignity” at the Catholic Notre Dame, Paris, articulating views harmonious with Catholic doctrine. In 2018, the European Federation of Catholic Doctors Associations and the Catholic Centre of French Doctors thanked him for valuable contributions to their thinking about human medicine.
Foreword 2 — Margaret Somerville
Professor of Bioethics at the (Catholic) University of Notre Dame Australia. (This is curious given that her CV mentions no earned tertiary qualification in either ethics or philosophy.) Somerville is a loyal Catholic who has for years been given pre-eminent position regarding Catholic bioethics above even the church itself at the L.J. Goody Bioethics Centre, as I’ve pointed out before.
The L.J. Goody Bioethics Centre is run by the Catholic Archdiocese of Perth. The Catholic Archbishops of Perth and Sydney are the ultimate controllers of the University of Notre Dame Australia.
Foreword 2 — Wesley Ely
Dr Wesley Ely is a Professor of Medicine at Vanderbilt University Medical Centre in Nashville, Tennessee. He is President of the Nashville Guild of the Catholic Medical Association. He has given numerous addresses from a Catholic perspective on topics such as “Preaching the gospel through service”, “Five principles of service in living the gospel”, “Deepening our prayer life”, “Viaticum: lessons learned from dying patients seeking our Lord”, “Top 10 tips at the heart of Christian discernment” and “A treatise on the true devotion to the blessed virgin by a lay doctor”.
Contributor — Eric Vermeer
Mr Vermeer is a nurse educator and the ordained Deacon of the Catholic diocese of Namur. His adopted son is also a Catholic priest. He is a past President of the European Institute of Bioethics, a group that claims to be independent and not of a religious nature, yet “attentive to religious traditions”. It lobbies for positions that are consistent with Vatican doctrine, such as against abortion and VAD. Quite a number of the Institute’s committees are known religious people, including some from the Catholic University of Leuven.
Mr Vermeer has recorded an anti-VAD video for ADF International, which runs the Arete Academy, a centre for religious academics based on “excellence and moral value”… at least according to their interpretation of the Bible.
Contributor — Catherine Dopchie
Dr Catherine Dopchie is an oncologist at the Centre Hospital of Wallonia. She told the Society for Religious Information Italy, published by the Catholic Press Agency, that “death is the enemy of mankind”, that “we have been created for life”, that “those who have met God in their lives, know that death is not the winner”, and that “every man is precious to God and that the entire life is sacred”.
Dr Dopchie has also recorded an anti-VAD video making unsubstantiated claims, for ADF International.
Contributor — Willem Lemmens
Having earned his doctorate at the Catholic University of Leuven, Professor Willem Lemmens is now Chair of the Department of Philosophy at the University of Antwerp. In 2018, Professor Lemmens argued against VAD at the (Catholic) Anscombe Bioethics Centre in the UK, and spoke with Catholic newspaper Crux, to spread the misinformation that Belgium’s law was originally only for terminal illness (it never was), and to complain that (Catholic) Belgian Brothers of Charity were now allowing VAD to occur in their healthcare facilities.
He also sits on the General Council of the University Centre Saint-Ignatius Antwerp, which was established by a Jesuit (Catholic) order, and whose purpose is to continue to promote Jesuit Christian ideology.
Contributor — An Haekens
Dr An Haekens was educated at the Catholic University Leuven. She is a psychiatrist and medical director at the (Catholic) Alexian Care Group in Tienen, Belgium. It was established by the (Catholic) Belgian Brothers of Charity and states that “we start from our own Christian identity” and “we want to keep alive and implement the spirituality of the Alexians”.
Dr Haekens writes periodically for Belgian Catholic magazine Tertio, including stating that she would never participate in VAD. In 2021 she was interviewed by Belgian Catholic radio station Radio Maria, having been awarded the annual prize for spiritual care by the Professional Association of Care Pastors, the association for Catholic chaplains.
She is married to Dr Didier Pollefeyt, Catholic Professor of Theology and Religious Studies at the Catholic University of Leuven. He is also an Honorary Professor at the Australian Catholic University.
Contributor — Rivka Karplus
Dr Rivka Karplus is a family physician and an internal medicine and infections specialist, based in Israel. In 2018 he attended a colloquium at the College des Bernardins in Paris — a Catholic theological and biblical studies centre — as a representative of the Jerusalem Kehilla, a congregation of Hebrew-speaking Catholics. He is warmly cited in a 2016 anti-VAD publication by the Catholic Caritas in Veritate Foundation, which attempts to provide representatives at the UN and other international organisations with Catholic, Christian “expertise and strategic thinking”.
Contributor — Marie Frings
Dr Marie Frings is a Brussells-based GP specialising in palliative care. She writes for Catholic group Consecrated Lives which promotes increasing evangelical commitments. In such an article in 2007, she cites the CatholicCongregation for the Doctrine of the Faith as an authority on end-of-life decisions, and notes that sometimes she felt uncomfortable that patients would have their arms tied to be force-fed against their wishes so they lived indefinitely. She firmed her views that tube feeding was not mandatory when it is an extraordinary measure, with the help of several Catholic theologians and the pro-life committee of the episcopal conference of American (Catholic) Bishops.
She argued “respecting the conscience of others” in this regard, yet expressly rejects such conscience when it comes to choosing a peaceful, hastened death by VAD.
Contributor — Benoit Beuselinck
Dr Benoit Beuselinck graduated from the Catholic University of Leuven in Belgium, and has for years worked in the university’s hospitals. In 2017 he spoke at an anti-VAD conference at the Catholic Anscombe Bioethics Centre in the UK.
In an article in the Catholic magazine Logia, he claims that “proper palliative care makes assisted dying unnecessary”, even though it is well-established that this isn’t true.
He alleges in the Catholic Herald that Belgian nurses and social workers are quitting their jobs because palliative care units are being turned into “houses of euthanasia”, and that doctors in palliative care units “have to euthanise patients”. He also claims that some patients are afraid to go to hospital in case they are either coerced into euthanasia or are deliberately killed without their consent. This is a perversion of the original Netherlands accusation by the Vatican, which itself was entirely false.
Dr Beuselinck has also made an anti-VAD video for ADF International, making unsubstantiated claims that “doctors hide behind their patients’ wishes”, “supply creates demand”, “the doctor has his back to the wall”, “we want euthanasia for everyone”, “doctors who prefer not to do it are not respected”. He cherry-picks Belgian non-voluntary euthanasia data to wrongly make the case that their VAD law has caused (or at least worsened) that practice; the opposite of the truth. He says that euthanasia is an act against nature, opens the floodgates, that we no longer favour the love we show in taking care of someone, and that the depressed may now think “if the doctor can kill, then what is my life worth?”
Contributor — Julie Blanchard
Dr Julie Blanchard is a French-trained GP who specialises in palliative care. She works at the Catholic University of Leuven’s second hospital, in Namur, and never participates in VAD. Contrary to Dr Beuselinck’s claims that palliative care workers opposed to VAD are disrespected and forced to participate, Dr Blanchard reports that other doctors respect her opposition, and that VAD teams take care to ensure those who are against VAD are not present at the time of a lethal injection.
It's astonishing how inconsistencies like this — those opposing VAD are respected but are not respected — reduce the book’s coherence.
Contributor — François Trufin
François Trufin is an emergency nurse at St Nikolaus Hospital in Eupen, Belgium. The hospital was founded and continues to be sponsored by the Catholic church, “continuing [the] obligation of the founders” for a “Christian worldview”.
Religious petticoats and the Catholic Communicator’s Guild
So there you have it: the Catholic connections of the people involved in the production of this risible nonsense, which brims with innuendo, arguments and misinformation consistent with those of the Catholic church and other Catholic apologists.
I’ve written before how Catholic Archbishop Anthony Fisher has expressly argued for organising a line-up of sympathetic (i.e. Catholic) doctors, lawyers and others to put such information about, and yet, how they hide their religious petticoats while doing so. I’ve further exposed a network of Catholics who promote the church’s line on VAD — a network I call the Catholic Communicator’s Guild.
This book furnishes an international example of the same principle: a group of Catholics promoting entrenched church lines on VAD, but hiding their religious petticoats all the while.
You may wonder how many times the word “Catholic” appears in said book. The answer is: exactly zero. And mentions of “religion” and “faith” appear as abstract and conceptual argument, e.g. if a person of faith…
Not the first time it’s been published
But a further issue arises in respect of this book: it’s not the first time it’s been published. It was published two years ago by Mols Editions (Wavre) under the title Euthanasia: Behind the Scenes — Reflections and Experiences of Caregivers. Tellingly, it was published in French and mentions the French parliament grappling with VAD law reform. (The current French VAD Bill, which appears to be supported by a majority of MPs, has been filibustered with well over 2,000 (two thousand) amendments submitted by just five MPs.)
Unlike the original which you have to buy, this Springer version is “Open Access”, meaning you can download the book from the publisher for free. So is this further edition vanity publishing?
The reason I ask is that Springer Publishing is owned by Springer Nature. That’s a company whose purpose is to make money for its owners via academic publishing. So publications have to be paid for either by sales, or by authors. Since there are no sales, the authors (or someone on their behalf) will have had to pay for the book.
According to their fee schedule, Springercharge US$15k (around AUD$20k) plus taxes for publishing a tome of this nature.
So: who paid for the book?
Conclusion
Far from a carefully researched collection of studies into VAD practice in Belgium, this polemical book relies heavily on the “moral intuitions” of innuendo, unverified anecdote and misinformation. It’s consistent with the propaganda put about by the Catholic church, yet not once throughout the entire book does anyone mention their deep Catholic connections. Indeed, you could be forgiven for thinking they’d taken some care to cover their religious petticoats.
A serious compendium of proper, scholarly studies of VAD practice, good and bad, is always welcome. This book is not it.
In my view, the tome does no favours for Springer, which has a solid reputation for academic and scholarly publication.
And, back to that 1990 TV commercial for boxes of breakfast cereal. It had popped into my head as an analogue: “Don’t mention it’s religious and they’ll publish it by the book-full.”
Blog by Neil FrancisPosted on Tuesday 27th April 2021 at 7:12pm
The Netherlands 2020 assisted dying report card confirms a steady rate
The Netherlands euthanasia commission has just released its 2020 annual report.
The report shows that the number of cases rose around 9% over the 2019 year. However, the number of total deaths was also up, resulting in a continuation of relatively level rate in recent years (Figure 1).
Figure 1: The assisted dying rate in the Netherlands and Belgium
With Covid-19 deaths having contributed towards a modest net increase in total deaths last year, the assisted dying rate is likely to be modestly higher in the coming year.
Blog by Neil FrancisPosted on Saturday 13th March 2021 at 11:57pm
"HOPE's" Branka van der Linden and the ACA misrepresent figures, again
Here we go again. Branka van der Linden of Catholic anti-VAD website “HOPE”, and the Australian Care Alliance — endorsed by a number of well-known, committed Catholic doctors — have just published more egregious misinformation against VAD. This time they've collectively piled it on Victoria's general suicide statistics, recently updated by the Victorian Coroner. So what did they say, and how did it misrepresent the actual situation? Let's take a look.
The reason the statistics are being discussed is because in 2017, Victoria's parliament legalised voluntary assisted dying (VAD) for the terminally ill. The law came into effect halfway through 2019, and 2020 was the first full year of its operation.
Australian Care Alliance gets the basics wrong
Here's the Australian Care Alliance's (ACA) splashy page trumpeting that Victoria's suicide rate has jumped 21.2% from 694 in 2017 to 842 in 2020.
Figure 1: ACA's splashy page trumpeting a 21.2% increase in Victorian suicides
That's... interesting. According to the Victorian coroner's official figures, there were indeed 694 suicides in Victoria in 2017. However, in 2020 the coroner's figure is actually 698, not 842 as claimed by the ACA. According to the ACA, Victoria's suicide count data looks like this (Figure 2).
Figure 2: The ACA polemically claims that Victoria's suicide count has increased 21.2%
So, how did the ACA reach a count of 842? Well, their argument is to shamefully and humiliatingly disrespect Victoria's terminally ill who died peacefully under its VAD law in 2020 — 144 of them according to the official 2020 reports of Victoria's Voluntary Assisted Dying Review Board — and add them to the coronial count of 698 suicides.
The ACA points out that VAD supporters have said that legalising VAD should decrease Victoria's general suicides by about 50 cases a year, but say the count's gone up substantially instead. See how they craftily deploy logical fallacy to fabricate a crisis?
Arguing that VAD law must reduce the suicide count by 50 cases a year (but seemingly didn't) and at the same time adding VAD cases to the suicide count to complain that it's gone up, requires at least three assumptions:
that all terminally ill violent suiciders now automatically qualify for and easily gain access to VAD; and
that nobody else with a terminal illness who would not have chosen violent suicide, should or would use the law; and
that no other factors make a significant difference to trends in general suicides.
All these assumptions are patently false.
Obviously, some people will not legally qualify for VAD; for example, amongst its restrictions it requires death to be expected with 6 months; 12 months for a small set of specific illnesses.
Obviously, some who would not have suicided but instead would suffer intolerably and against their wishes until death, will now choose to pursue VAD.
And obviously, well-known factors such as rates of mental illness, substance abuse, intimate relationship troubles, bullying, financial or legal difficulties, and other factors are major influencers of general suicide rates. But to the ACA, the only factor that supposedly has any effect is the one they are ideologically opposed to: VAD.
It's worrisome that this nonsense is sold to the public by ACA's supposed experts: “health professionals and lawyers”.
Cherry-picked overseas data, too
The ACA's ideological bias is further revealed by their website page about the “social contagion of suicide”. In it, they cite as authoritative, the 2015 Jones and Paton (both firm Catholics) article purporting to show 6.3% suicide contagion from VAD to the general population. I've comprehensively exposed that article as an ideologically-driven mathematical farce fuelled by no fewer than ten major scientific offenses. It's interesting that the ACAs methodology is just like Jones' and Patons': reporting VAD supporter statements that legalisation should decrease the general suicide rate, and then adding VAD deaths to conclude the opposite.
They also commit one of Jones' and Patons' other offences: selectively quoting data from other studies that might be seen to support their theory, but excluding critical alternative information from the same study that runs counter to the theory.
The ACA cites a Swiss study to breathlessly report that 6.5% of those who witnessed an assisted death in that country experienced sub-threshold PTSD, and 13% full PTSD. The ACA expressly states:
“Like any other suicide, assisted suicide can profoundly affect surviving family members and friends.” — The Australian Care Alliance
There you have it: the ACA draws a direct equivalence between peaceful VAD deaths in the face of terminal illness and with loved ones present, and lonely, violent deaths by general suicide.
The ACA cites no other relevant material from the Swiss article. That's revealing, because the article clearly reported that the PTSD rates were higher than in the general population. There's what the ACA left out: the PTSD rates were higher than for almost everyone else who hadn't just suffered the loss of a loved one.
To draw valid and meaningful interpretations, it is necessary to compare the bereavement challenges of VAD family versus families of general deaths, deaths in the face of extreme suffering without hastened death, and cases of violent suicide. As I've published before from peer-reviewed studies, bereavement symptoms of VAD family are at least as good as, and can be better than those where the deceased has suffered in extremis at the end of life, and certainly relative to violent suicides.
The ACA also doesn't mention that the Swiss study found a "prevalence of complicated grief ... comparable to that reported for the general Swiss population". It's not like the information was hard to find. It's right there in the Abstract on the front page of the article.
That the ACA cherry-picked a couple of Swiss data points while omitting key “unhelpful” information, and argued, by linking the selected cherries with the above quote, that said Swiss data established something it clearly did not (that VAD deaths supposedly cause similar family trauma as violent suicides), suggests an astonishing degree of ignorance.
The ACA's cherry-picking of data, while omitting key unhelpful information, suggests an astonishing degree of ignorance.
Enough of that.
Branka van der Linden cherry-picks, too
I've crossed pens (or is that keyboards?) with Ms van der Linden several times before in regard to misinformation. She misinforms on this matter, too.
Curiously, like the ACA and also without explanation, she cherry-picks just the 2017 and 2020 suicide counts from the Victorian coroner's report (Figure 3). You'd think this was the only data in the report, but no, it isn't.
Figure 3: Branca van der Linden's version of Victorian suicide counts by year
She uses these two figures to argue that said drop of 50 cases per year hasn't happened. This employs the same fallacies as the ACA: suggesting that two single data points strongly support a hypothesis, and assuming that the thing one is ideologically opposed to, VAD, is the only thing to alter the rate of general suicides over time.
Like the ACA, she also suggests adding the VAD figures to the coroner's general suicide data to say that in that case, suicides have increased significantly.
Both the Australian Care Alliance and Branca van der Linden cherry-pick just two data points from more full and robust longitudinal data to try and argue their case against VAD.
So what does the coroner's full data set look like?
The actual numbers
The Victorian coroner's 2021 report into suicides contains data for all years 2016 to 2020 inclusive. And it looks like this (Figure 4).
Figure 4: The complete set of data from the Victorian coroner's report on suicide counts per year
Now we're beginning to see a possible reason as to why the ACA and Ms van der Linden chose just two data points. Remember that VAD was legalised by the Victorian parliament in 2017. The law was not in effect for 2017, 2018, or the first half of 2019.
Well, the data clearly suggests an increasing suicide count trend up to 2018. The upward trend stops in 2019, when VAD was in operation for the second half of the year. And in 2020, the first full operational year of VAD, the upward trend has been interrupted by a downward result. Neither the ACL nor Ms van der Linden mention this.
Neither the Australian Care Alliance nor Branca van der Linden mention the fuller, longitudinal data that doesn't support, and indeed appears hostile to, their hypothesis.
Update 19-Mar-2021
I thought it so obvious that I didn't write it up, but a colleague points out it's important to highlight, that in picking just two data points to stake their claim, the ACA and Ms van der Linden chose 2017, and not 2018, as their reference year. To compare “after” with “before” in the most basicly valid manner (full longitudinal data is better), it is appropriate to compare the last data point that completely excludes the new condition (VAD law in operation), with the first data point that fully includes it.
Those years are 2018 (none of the year) and 2020 (all of the year). But the ACA and Ms van der Linden didn't pick 2018, they picked 2017.
What possible reason might explain that? Well, by comparing 2017 with 2020, they got to say that the general suicide count increased by 2 from 694 to 698. However, had they more validly compared 2018 with 2020, they would have had to report a drop of 19 from 717 to 698.
And that would have contradicted their flimsy confection that suicides hadn't gone down after VAD was introduced.
But even the raw suicide count statistics are a bit misleading.
Interpreting suicide data correctly
Using raw counts to compare suicide statistics (e.g. year to year or place to place) is lazy and wrong. All other things being equal, if you had twice the population, you'd expect twice the suicide count. To make valid comparisons, you have to compare rates, not raw counts. This is relevant because populations obviously change over time, and Victoria between 2016 and 2020 was no exception.
I've retrieved the official Victorian population figures by year and computed the standard official suicide rate statistic: suicides per 100,000 population. The Victorian suicide rates look like this (Figure 5):
Figure 5: Victorian suicides per 100k population by year
The data shows a rising suicide rate from 2016 to 2018, a levelling off in 2019 in which VAD was operational for half the year, and a fall back to the 2016 rate in 2020, the first full operational year of VAD.
Computing from the rate drop between 2018 (11.4 with no VAD law) and 2020 (10.8, first full year of VAD law), the equivalent count of suicide decrease in 2020 was 38 persons. And that's without assuming the general suicide rate would have continued its rising trend.
The equivalent suicide decrease from 2018 to 2020 was 38 persons.
Getting all the numbers right
The ACA correctly cites then Minister for Health, Ms Jill Hennessy, as stating in 2017 that "Evidence from the coroner indicated that one terminally ill Victorian was taking their life each week." That would be 52 cases a year, which the ACA rounds out to 50 a year. The headline figure from the coroner's report actually calculates to 48. No biggie, just round numbers.
But the figure is quite wrong. You have to read the coroner's special 2017 report to the Victorian parliament regarding suicides in cases of illness, to calculate the correct numbers.
The coroner's report didn't just include suicide data for terminally ill people. It also included cases of advanced incurable but not terminal illness, and cases of severe suffering resulting from injuries. So the terminal illness data (to which the VAD law is relevant) is a fraction of the total. We can calculate from the Tables in the report that 23% of the cases were in respect of injuries, so that leaves 77% for terminal and other advanced illnesses.
Of the illnesses listed, the relevant one as a proxy measure for terminal illness is “cancer”, and that comprises 50% of the illness cases. So, 50% of 77% of 48 cases a year = 19 cases a year in respect of terminal illness.
So that's an actual likely decrease of 19 suicide cases a year, compared with an equivalent drop in the actual data of 38 persons in the first full year.
The actual annual count of general suicides in respect of terminal illness, as reported to the Victorian parliament by the state coroner in 2017, was 19 persons a year, and not 50 as widely stated.
Don't get carried away
It's imporant to note that citing this interesting numeric analysis as “proof” of the law's effectiveness in respect of reducing Victoria's suicide rate, would, at present, be an overconfident claim. While far more firmly based in proper forms of evidence than the vapid nonsense promoted by the ACA and Ms van der Linden, this is a correlation. Correlation does not equal causation: the ACA and Ms van der Linden should remember that. For example, 2020 was a very unusual, Covid-19-dominated annus horribilis, which may have affected suicide rates in unexpected ways.
While the coroner's fuller data set so far is consistent with reasoned expectations of suicide substitution, it is premature to conclude the data proves the principle. More years' data, and more detailed, causative analysis involving the control of confounding factors, is necessary before reaching greater certainty in the association.
But as I've published in detailed and extensive analyses based on robust official data, so far all the longitudinal data on suicide rates in jurisdictions where VAD is lawful is consistent with suicide substitution, not suicide contagion. Some VAD opponents just cherry-pick their way through tidbits to try and argue the opposite.
To date, all the robust, longitudinal data on suicides in jurisdictions where VAD is lawful is consistent with suicide substitution, not suicide contagion.
Conclusion
The Australian Care Alliance and Ms van der Linden disgracefully cherry-pick and misrepresent Victoria's recent suicide data in a manner consistent with their own theories, while proper and appropriate analysis of the full data available shows results inconsistent with their hypothesis, and currently consistent with the opposite.
To paraphrase Ms van der Linden's own statement: “It is unfortunate that the deaths of terminally ill Victorians were politicised so shamelessly by [anti-]euthanasia activists for their own ends.”
These continued cherry-picked data gaffes are an embarrassment to their promoters.
Blog by Neil FrancisPosted on Wednesday 3rd March 2021 at 9:32pm
Beligum and Oregon released their annual VAD reports this week.
Belgium and the USA state of Oregon both released their annual voluntary assisted dying (VAD) reports this week. I report on the numbers.
While the Netherlands and Washington state haven't released their 2020 annual VAD report cards yet, Belgium and Oregon have.
Belgium
Back in 2016 I wrote a detailed Whitepaper on assisted dying practice in Benelux, including data up to 2015. In it, I pointed out that in several years' time the trend to increasing rates of VAD would level off, like a sigmoidal (stretched-S shape) curve, as does most human adoption of new behaviours.
That time has arrived. The most recent data from both the Netherlands and Belgium shows that in both countries, the VAD rate, as a proportion of all deaths, has generally levelled off (Figure 1).
Figure 1: VAD deaths as a proportion of all deaths in the Netherlands and Belgium
Sources: Official Euthanasia Commission reports; Government total death statistics
The cultural rate of VAD in the Netherlands appears to be around 4.3% of all deaths, while in Belgium it's around 2.4%. No doubt these figures will vary slightly over coming years, but shrill pronouncements that the rate would continue to rocket higher and higher are refuted by the evidence.
That Belgium's “level” VAD rate is significantly lower than the Netherlands' despite quite similar (though not identical) laws, suggests that VAD rates are influenced more by cultural and other factors beyond the specific provisions of formal statutes and regulations.
Oregon
Meanwhile, in the state of Oregon, the Death With Dignity Act (DWDA) was revised in 2019. Previously, some people suffering intolerably at the very end of life were excluded from using the Act if they died within 15 days of deciding to use the Act. This was due to a fixed, mandatory 15-day cooling off period. Yet in the last weeks and months of life, an individual's condition can take a sudden and dramatic turn for the worse, so that previously the person may have not qualified for other reasons or felt they still had time to apply for access, and now would not qualify the 15 day cooling off period.
The cooling off provisions were updated by Oregon's legislature in 2019 to allow access without the cooling off period, in cases where the person is, in professional medical opinion — and with a formal declaration to the effect — reasonably likely to die before the 15 days had elapsed.
The revision was in effect for the entire 2020 calendar year.
As a consequence, some people felt they didn't need to apply quite so early “just in case” they might want to use the law, while others who would have been excluded altogether were able to use the law. This accounts for a slight dip in the “old” provisions rate, along with a rise in the total proportion of DWDA deaths (Figure 2).
Figure 2: Oregon DWDA deaths as a proportion of all deaths, new-rule data in light blue
Source: Oregon DWDA annual reports; Government total death statistics
Oregon's overall rate of VAD remains much lower than in the Netherlands and Belgium, whose laws are not restricted to cases of terminal illness.
However, in no case has any parliament legislated to limit cases to a numbered cap. In all jurisdictions, legislation focuses on the conditions under which a person may become eligible to access VAD choice, regardless of the actual numbers requesting and qualifying for access.
Blog by Neil FrancisPosted on Sunday 4th October 2020 at 4:13am
There's a good reason why assisted dying opponents don't mention Switzerland. [Photo by Andrew Bossi]
Supposed Dutch suicide contagion from assisted dying
Recently, Dr Theo Boer, an Assistant Professor at a "black-stocking" (strongly conservative Protestant) theological college in the Netherlands, was at it again — criticising the Dutch euthanasia law to anyone who would listen: "don't follow the Dutch euthanasia law path because it leads to 'suicide contagion'".
I've exposed Prof. Boer's cherry-picked nonsense before. Astonishingly, he even ignores data from the Dutch Euthanasia Commission, despite the fact he used to serve on one of its five Regional Review Committees.
What he doesn't mention is that amongst the five Regions, the Region with by far the highest rate of assisted deaths had the second-lowest rate of general suicide, and the Region with the lowest assisted death rate had by far the highest general suicide rate (Figure 1) in 2014,1 the year Boer left his Committee and began bad-mouthing the Dutch law. Quite the opposite of "suicide contagion".
Figure 1: Dutch assisted death and general suicide rates by region, 2014
From multiple safeguards to just one
The Dutch euthanasia Act has a number of safeguards that stipulate who may qualify to access assisted dying in the Netherlands, and how qualification is assessed, implemented and reported to the authorities.
But there's another country that permits assisted dying with just one provision: Switzerland.
In effect since 1942, an exception in the Criminal Code permits assisted suicide, provided assistance is rendered for non-selfish motives. That's it. There's no legislated (or even government-regulated) requirements for age, illness or condition, decisional capacity, cooling off periods, or anything else.
In the 1980s, two assisted dying associations were formed to make assisted dying generally possible: Exit Deutsche Schweiz for German-speaking Swiss residents, and Exit A.D.M.D. for French-speaking residents.
Since then, several other smaller associations have been formed, including in 1998 Dignitas, which provides assistance to foreigners. (The main societies assist only Swiss residents.) The current membership of the societies, combined, is well in excess of 150,000 people, in a population of just 8.5 million. Assisted dying is often discussed openly in the media.
If "contagion" anywhere, in Switzerland, right?
Given that Switzerland has an abundance of the ingredients that religious opponents of assisted dying claim lead to "suicide contagion", you'd think they'd be shouting about Swiss "suicide contagion" from the rooftops.
But they don't mention Switzerland.
There's a powerful reason why: the data is not only unhelpful to their "contagion" theory, but actively hostile to it.
Latest official government data
I've written about Switzerland before, but, given the ongoing "suicide contagion" misinformation, I thought an update warranted. On request, my contact in the Swiss Federal Statistical Office (FSO) promptly re-supplied all publicly-available statistics of assisted deaths and general suicides, with the data now running up to 2017.
It makes for interesting reading. Figure 2 shows Switzerland's (CH) long-term general (non-assisted) suicide rate, along with the domestic (Swiss resident) and Dignitas (foreigner) assisted death rates. All the official (Australian Bureau of Statistics) longitudinal data I could find for Australia's (AU) general suicide rate is also included.
Figure 2: Swiss death rates 1969–2017; Australian suicide rates 1990–2017
Immediately obvious is that the Swiss general suicide rate has dropped massively and consistently since the two main assistance societies were formed in the early 1980s. And it's continued to drop even as the rate of assistance, and public discussion, has increased over the most recent three decades.
I also asked the FSO how many cases on record were of minors (persons under the age of majority or 18 years). The answer? None. I double-checked. Zero. Zip. No minors receiving assisted dying in Switzerland. Indeed, cases under the age of 35 years old are uncommon.
Consistent with best practice
Indeed, the data is consistent with suicide prevention. The societies help people get the medical care they need and consider assisted death only when other avenues have failed to provide acceptable relief. Every assisted death is reported as such by the association to the authorities — otherwise the unexpected death would result in a coronial inquiry.
Each association has clearly-defined processes and oversight by ethics specialists. Clients requesting access are assessed carefully by doctors. (In fact, the lethal medication can only be lawfully obtained by medical prescription.) The associations take their responsibilities very seriously.
The data is also consistent with substitution: that what would have been some violent and lonely suicides as a result of unrelievable suffering from intractable conditions, are now peaceful assisted deaths.
And for the record, despite the Swiss law being in effect since 1942 versus Dutch regulation from only 1984; and Swiss law having only one provision versus Dutch regulation/legislation with many; in 2017 the Swiss assisted dying rate, including Dignitas cases, as a percent of all deaths, was less than half that of the Netherlands' rate.
Reasons for requesting an assisted death
Exit Deutsche Schweiz, by far the largest of the Swiss associations, has published statistics of its cases (Figure 3).
In 2015, like other jurisdictions, cancer was by far the most common reason (40.8%) for requesting an assisted death. Polymorbidities (22.4%) was next, followed by refractory pain at 8.6%, lung diseases at 5.0% and Parkinsons at 4.3%.
Despite no government-regulated access requirements, assistance for mental illness was very low at 1.7% (Dutch 1.2% in 2015) and cases of dementia at 1.4% (Dutch 2.0%; Belgian combined mental/dementia 3.1% in 2015).
And compared to Australia?
In the 1990s, the Swiss general suicide rate, although falling, was significantly higher than Australia's (Figure 2) until 2010, when the rates were the same. Since 2010, the Swiss suicide rate (with no legislated procedures for its permitted assisted dying) has continued to drop, while Australia's (at that time with no assisted dying law at all), began to rise.
This difference highlights the clear anchoring bias exhibited by religious opponents who cherry-pick their data to try and claim the rise in the Dutch general suicide rate must be the result of "suicide contagion" from assisted dying, when Australia's rate also increased over the same time period, but in the complete absence of an assisted dying law. (Victoria's assisted dying legislation didn't come into effect until mid-2019.)
Further, the Swiss rate has continued to drop even with a significant increase in assisted dying.
Conclusion
Of course, general suicide is a serious issue. It has numerous well-known risk factors (e.g. mental health, substance abuse, unemployment, relationship breakdown, opportunity) and protective factors (e.g. hotlines, funding mental health programs, unemployment benefits, removing opportunity), none of which assisted dying opponents mention while cherry-picking their statistics.
Meanwhile, as legislators contemplate the specific safeguards contained in Bills before their legislatures, it's important to strike an appropriate balance between sufficient safeguards, and inappropriately requiring those considering an assisted death to climb Mount Everest with one hand tied behind their backs.
Switzerland shows that even in a jurisdiction without legislated practices, access to assisted dying is modest, with assistance groups establishing their own stringent ethical and procedural standards.
And it amply demonstrates even under those conditions, an absence of supposed "suicide contagion".
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1 Official Euthanasia Commission data and official Dutch government suicide statistics by region.